Salvage of a failed open gastrocutaneous fistula repair with an endoscopic over-the-scope clip

Abstract Once enteral access via gastrostomy tube (G-tube) is no longer indicated, the tube is typically removed in clinic with a high probability of spontaneous closure. When spontaneous closure is not achieved, the formation of a gastrocutaneous fistula (GCF) is possible. The incidence of GCF is directly related with the length of time the tube has been placed. When conservative management fails, surgical intervention is the standard treatment. Endoscopic techniques have been described for primary closure of GCF in adults including banding and cauterizing of the fistula tract with placement of a standard endoscopic clip. Over-the-scope clips (OTSC) have recently been reported in primary GCF closure in children (Wright et al., 2015). In patients with skin irritation surrounding a GCF making surgical repair difficult, endoscopic OTSC closure provides particular benefit. It is our belief that this is the first case report of endoscopically salvaging a leak from a failed open GCF repair.